Comparison of the most favoured methods for the diagnosis of hepatic encephalopathy in liver transplantation candidates

Goldbecker, Annemarie; Weißenborn, Karin; Shahrezaei, Golschan Hamidi; Afshar, Kambiz; Rümke, S.; Barg‐Hock, Hannelore; Strassburg, Christian P.; Hecker, Hartmut; Tryc, Anita Blanka

doi:10.1136/gutjnl-2012-303262

Cited by 83 publications

(98 citation statements)

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“…In accordance with earlier reports from us and from others we found a high proportion of patients with abnormal psychometric tests (Lauridsen et al 2012;Patidar et al 2014;Nabi et al 2014;Bajaj et al 2014;Li et al 2013). Also, more patients had abnormal results when more than one psychometric test was applied; a phenomenon also present in our earlier study on the CRT and the Critical Flicker Frequency Method (Lauridsen et al 2011) and in reports on the use of a battery of tests (Montagnese et al 2011;Goldbecker et al 2013;Sharma et al 2010;Maldonado-Garza et al 2011). This seems not necessarily to imply that all patients would be afflicted if enough tests were applied.…”

Section: Discussionsupporting

confidence: 91%

Minimal hepatic encephalopathy characterized by parallel use of the continuous reaction time and portosystemic encephalopathy tests

2015

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Minimal hepatic encephalopathy (MHE) is a frequent complication to liver cirrhosis that causes poor quality of life, a great burden to caregivers, and can be treated. For diagnosis and grading the international guidelines recommend the use of psychometric tests of different modalities (computer based vs. paper and pencil). To compare results of the Continuous Reaction time (CRT) and the Portosystemic Encephalopathy (PSE) tests in a large unselected cohort of cirrhosis patients without clinically detectable brain impairment and to clinically characterize the patients according to their test results. The CRT method is a 10-minute computerized test of a patient's motor reaction time stability (CRTindex) to 150 auditory stimuli. The PSE test is a 20-minute paper-pencil test evaluating psychomotor speed. Both tests were performed at the same occasion in 129 patients. Both tests were normal in only 36% (n = 46) of the patients and this group had the best quality of life, a normal CRP, a low risk of subsequent overt HE, and a low short term mortality. Either the CRT or the PSE test was abnormal in a total of 64% of the patients (n = 83), the CRT in 53% (n = 69) and the PSE in 34% (n = 44). All these patients had a poorer quality of life, low-grade CRP elevation, moderate risk for subsequent overt HE, and a higher than 20% short term mortality. Both tests were abnormal in 23% (n = 30) of the patients and this group had more advanced cirrhosis and a 40 % short-term mortality. One of the tests was abnormal in the majority of the patients but concordant in only 60%. Most cirrhosis patients seem to have impairments of different cognitive domains and more domains with advancing disease. Two abnormal tests identified patients with an increased risk of overt HE and death.

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Section: Discussionsupporting

confidence: 91%

Minimal hepatic encephalopathy characterized by parallel use of the continuous reaction time and portosystemic encephalopathy tests

2015

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“…The results achieved with these different tools are not congruent. Goldbecker et al [36] recently compared the sensitivity and specificity of the PHES, ICT, CFF and the repeatable battery for the assessment of neuropsychological status (RBANS) for diagnosing HE. They showed a high sensitivity of the PHES and the number of targets in the ICT (85.7%) combined with a specificity of about 97%.…”

Section: Discussionmentioning

confidence: 99%

The Clinical Relevance of Minimal Hepatic Encephalopathy - A Critical Look

Weißenborn¹

2015

Dig Dis

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Minimal hepatic encephalopathy (mHE) is diagnosed in patients with severe liver disease but no clinical symptoms of encephalopathy if either neuropsychological or neurophysiological tests indicate cerebral dysfunction and other possible causes of brain dysfunction have been excluded. mHE is characterized by deficits in attention, visuospatial orientation, visuoconstructive abilities and motor function. Accordingly, mHE can be expected to interfere with a subject's working ability, especially in those occupations that require handiwork, and driving ability. Indeed, about 60% of blue-collar workers with mHE have been shown to be assessed as unfit for work compared to only 20% of white-collar workers, and about 50% of patients with mHE have been judged unfit to drive a car in several studies. mHE interferes with a patient's quality of life and is associated with an increased risk of developing overt HE as well as increased mortality. Whether mHE is of importance for cognitive function after liver transplantation has still to be clarified.

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“…As potential mar kers of MHE researches list routine markers of liver inflammation and fibrosis as well as proinflammatory cytokines -TNF-α, IL-1, IL-6 (4,8,(21)(22)(23)(24)(25). Most recent studies are concentrated on IL-6 and IL-18 role in MHE pathogenesis (26)(27)(28).…”

Section: Introductionmentioning

confidence: 99%

“…From the clinician point of view, computerized tests such as an inhibitory control test or a critical flickers frequency test can be among perspective MHE diagnostic tools (8,(16)(17)(18)(19)(20).…”

Section: Introductionmentioning

confidence: 99%

Value of computerized inhibitory control test and blood tests in minimal hepatic encephalopathy diagnosis

Savlan¹,

Liakina²,

Valantinas³

2013

AML

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Background. Minimal hepatic encephalopathy (MHE) can be diagnosed by “paper-pencil” tests, computerised inhibitory control or critical flicker frequency tests, but for clinical practice more convenient methods of diagnosis are being searched. The aim of the study was to assess the value of inhibitory control test (ICT) and laboratory blood tests (leucocytes, platelets, hemoglobin, AST, ALT, ALP, GGT, bilirubin, albumin, SPA, INR, glucose, ammonia, IL-6) for MHE diagnosis. Materials and methods. 62 cirrhotic patients without overt hepatic encephalopathy were enrolled in the study. The control group consisted of 53 volunteers without chronic liver diseases. Routine laboratory tests, IL-6 of venous blood samples and ammonia of the capillary blood were extracted after overnight fasting. Ammonia was measured by the micro-diffusion method. IL-6 concentration was detected using the solid phase chemiluminescence immunometer analysis. At the same day all participants performed the PHES (Psychometric Hepatic Encephalopathy Score) battery and ICT under recommended diagnostic standards. Results. MHE was diagnosed in 44/71.0% out of 62 cirrhotic patients while 18/29.0% had no evidence of psychomotor or cognitive disturbances. There was not statistically significant difference in age, gender, education. Patients with MHE had statistically significant differences neither in leukocytes, platelets count nor in ALT, AST, ALP, GGT, IL-6, albumin, SPA, INR, bilirubin concentration in comparison with those without MHE. Patients with MHE perform ICT worse than those without MHE but the differences were not statistically significant. Conclusions. In our study ICT was not approved as a good diagnostic tool for MHE. The IL-6 concentration in the peripheral blood as well as routine biochemical tests seem not useful for MHE diagnosis in cirrhotic patients.

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Comparison of the most favoured methods for the diagnosis of hepatic encephalopathy in liver transplantation candidates

Abstract: In the German population of patients awaiting liver transplantation, PHES is the most robust method for the diagnosis and follow-up of HE.

Cited by 83 publications

References 31 publications

Minimal hepatic encephalopathy characterized by parallel use of the continuous reaction time and portosystemic encephalopathy tests

Minimal hepatic encephalopathy characterized by parallel use of the continuous reaction time and portosystemic encephalopathy tests

The Clinical Relevance of Minimal Hepatic Encephalopathy - A Critical Look

Value of computerized inhibitory control test and blood tests in minimal hepatic encephalopathy diagnosis

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